How to Choose a Rheumatologist
When you have pain in your joints or bones that your primary care doctor has been unable to ease, you may want to consult a rheumatologist. But how do you find the right fit?
This includes various forms of arthritis, such as:
A rheumatologist can also help diagnose and treat tendonitis, osteoporosis, bursitis, and inflammatory back pain. In addition, rheumatologists treat systemic autoimmune diseases such as lupus, Sjögren’s syndrome, and scleroderma.
How do you know when the time is right for you to see a rheumatologist?
“That’s a difficult question,” says James Udell, MD, a rheumatologist with the Arthritis Group of Philadelphia and Bucks County in Pennsylvania. “It’s easier to know with some other specialties. For example, if you can’t breathe, you see a lung doctor, and if you’re having loose stools, you see a gastroenterologist,” he notes.
As soon as you suspect you have a bone or joint problem, check in with a rheumatologist, suggests Udell. “The earlier we see a patient, the better they will do in the long run.”
Most of us have joint or muscle pain on occasion, but if it doesn’t resolve, your primary care doctor may refer you to a rheumatologist. If you have a family history of autoimmune disorders or rheumatic diseases, the ACR suggests you consider an earlier visit to a rheumatologist. The sooner you are diagnosed, the sooner you can begin treatment and prevent joint damage.
RELATED: Rheumatoid Arthritis Diagnosis
To find a rheumatologist, you can:
“Rheumatologists understand the biology of autoimmune diseases and are well equipped with information to target and treat them,” says Seth D. Ginsberg, co-founder and president of the Global Healthy Living Foundation, an advocacy group for people living with chronic illnesses. A family practitioner may not have the depth of knowledge about some of these syndromes.
The best case scenario is having a primary care practitioner as well as a rheumatologist who both regularly coordinate arthritis care, Ginsberg notes. “As I was growing up, my pediatric rheumatologist used to send a report to my pediatrician after every visit. That made my file, back when they were kept in folders, very thick for both doctors. But it was important to have as much documented as possible,” he says.
The right rheumatologist for you may depend on your specific needs and communication style. Here are some tips to help you find the best specialist for you:
“I looked for a gentle, confident, wise, reassuring bedside manner,” says Ginsberg. “I was interested in someone I could relate to, have a conversation with, and explain my situation to in broader terms than just my aching joints. My wife came with me during the first visit and joined us in the exam room. Her opinion mattered, too,” says Ginsberg.
Udell agrees that one of the first things to consider is the doctor’s personality and how well it gels with yours, especially if your disease is a serious, chronic one such as RA.
RELATED: 10 Questions to Ask Your Doctor About Rheumatoid Arthritis
The doctor-patient relationship should be nurtured as time goes on, Udell adds. If there’s an issue that the patient and physician don’t see eye-to-eye on, for example, they need to discuss it.
Or you might want to be more aggressive about treatment options while your doctor wants to be less aggressive — this is also something important to discuss, he says.
Traci Lynn Martin, a neonatal ICU nurse and expedition kayaker from Lee’s Summit, Missouri, found out she had RA and went to a few rheumatologists before she found the right chemistry.
“The first person I saw I didn’t like,” Martin says, “because I didn’t feel like he was listening to me. He had a formula with questions and it wasn’t personalized. It was important for me to stay active, to be able to do my triathlons, and long distance kayaking that I had done my whole life.”
Friends referred her to other specialists, but she knew right away when she found the right rheumatologist. “He sits down and doesn’t rush in and out and doesn’t leave the room until I am happy,” Martin says. “I walked out of there so happy after the first visit, I felt like I had someone who was listening to me for the first time since my diagnosis.”
“What I would suggest for anyone who is getting ready to see a new doctor is to sit down before you go and write down on a piece of paper why you are going and what you are hoping to accomplish with your visit,” says Martin. “If you have everything written down when they come into the room, I think the doctors themselves will sit down and be a little bit more patient.”
At your initial appointment, your rheumatologist will perform a thorough physical exam and discuss your symptoms with you. They may also run lab tests.
Common concerns may include:
Also be prepared to listen and take notes, or record the conversation on your phone or another device. You’ll likely be hearing a lot of new information and having a record to go back to can help keep you from getting overwhelmed.
RELATED: How to Have an Effective Appointment With Your Rheumatologist
Be wary of someone who doesn’t look you in the eye; eye contact is crucial, Ginsberg believes.
If the doctor’s head is buried in your chart or electronic health record during your appointment, that’s a red flag. You want someone who relates to you, not your chart or lab results, he says.
Another major red flag is when doctors, nurses, or other members of the office staff don’t respond to your phone calls.
There has been a shortage of rheumatologists in America — as well as many other developed countries — for the last decade or so, says Vinicius Domingues, MD, a rheumatologist in Daytona Beach, Florida.
But that doesn’t mean that you can’t get good treatment from your primary care physician if that’s what your situation requires. “The advancement in the medical community’s understanding about the causes and the treatments of arthritic conditions, as well as the evolution of telemedicine, has allowed primary care physicians to diagnose and treat most common forms of arthritis,” says Ginsberg.
Dr. Domingues also recommends looking into support groups. “The American College of Rheumatology has good support groups. CreakyJoints, an advocacy, education, and support group for people living with arthritis and rheumatic disease, also has forums and resources that should be explored,” says Domingues.
Additional reporting by Deborah Shapiro.
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